Anterior cruciate ligament(ACL)injuries are among the most frequent knee pathologies,with athletes—particularly females and those in pivot-heavy sports such as soccer,basketball,volleyball,and skiing—at increased ri...Anterior cruciate ligament(ACL)injuries are among the most frequent knee pathologies,with athletes—particularly females and those in pivot-heavy sports such as soccer,basketball,volleyball,and skiing—at increased risk.The success of ACL reconstruction is multifactorial,relying on individualized graft selection,surgical precision,patient-specific characteristics,and optimized rehabilitation.Despite the availability of various graft options—hamstring tendon,bone-patellar tendon-bone,and quadriceps tendon—no single type has demonstrated clear superiority,reinforcing the need for patient-tailored approaches based on anatomical,functional,and age-related factors.Surgical techniques continue to evolve,with adaptations such as physeal-sparing methods for skeletally immature patients and minimally invasive procedures aimed at reducing morbidity and improving recovery.Rehabilitation is a critical determinant of functional out-comes.Current evidence supports immediate mobilization,early weight-bearing,and initiation of neuromuscular and strength training,while routine use of continuous passive motion and bracing is discouraged,except in multi-ligament injuries.Prehabilitation is recommended,though accelerated rehabilitation remains controversial.Implant choice and fixation strategy are also essential to long-term success.The use of materials that reduce the risk of chronic complic-ations and support biological integration is increasingly favored.Nevertheless,rare mechanical failures emphasize the need for accurate tunnel placement,appropriate implant selection,and vigilant postoperative monitoring.Outcomes are further influenced by patient-specific variables,including bone quality,metabolic status,and physical activity levels.Optimal ACL reconstruction results from a comprehensive,patient-centered strategy that integrates surgical accuracy,individualized rehabilitation,and continuous follow-up to minimize complications and enhance recovery.展开更多
We still do not have comprehensive knowledge of which framework of patientcentered care(PCC)is appropriate for diabetes care,which elements of PCC are evidence-based,and the mechanism by which PCC elements are associa...We still do not have comprehensive knowledge of which framework of patientcentered care(PCC)is appropriate for diabetes care,which elements of PCC are evidence-based,and the mechanism by which PCC elements are associated with outcomes through mediators.In this review,we elaborate on these issues.We found that for diabetes care,PCC elements such as autonomy support(patient individuality),cooperation and collaboration(system-level approach),communication and education(behavior change techniques),emotional support(biopsychosocial approach),and family/other involvement and support are critically important.All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation.We present the practical implications of these PCC elements.展开更多
This article aims to study methodologically hospital buildings and, in particular, the design of day clinics in the recovery area. The definition of design guidelines to improve and qualify the day clinic, enhancing t...This article aims to study methodologically hospital buildings and, in particular, the design of day clinics in the recovery area. The definition of design guidelines to improve and qualify the day clinic, enhancing their performance, takes into account the fact that the established requirements of medical protocols must be accompanied by those new requirements related to the massive evolution in health organizations. Changes in medicine, culture and society have necessarily led to a new formulation of the hospital model and the introduction of the theme of the humanization of the curing process has conditioned the morphological-space configuration and the presence of new relationships and spatial functions in the hospitals. The research of this article attempts, therefore, to explore the use of technology to improve the quality of day clinics’ design, formulating strategies that contribute on one side to facilitating the efficiency of service, and on the other side to making the user feel at ease in a welcoming and comfortable environment.展开更多
The coronavirus disease-19(COVID-19)pandemic has been a wake-up call in which has forced us to react worldwide.Health policies and practices have attracted particular attention in terms of human and financial cost.Bef...The coronavirus disease-19(COVID-19)pandemic has been a wake-up call in which has forced us to react worldwide.Health policies and practices have attracted particular attention in terms of human and financial cost.Before COVID-19,chronic kidney disease was already considered a risk multiplier in patients with diabetes and hypertension,the two now being the major risk factors for COVID-19 infection and adverse outcome.In contrast to the urgent need for action,the nephrology field is considered to be in a state of stagnation regarding the management of chronic kidney disease patients who still experience unacceptably high morbidity and mortality.Ironically and paradoxically in a field lacking robust clinical trials,clinical practice is driven by guidelines-based medicine on weak evidence.The Emperor’s syndrome,referring to Hans Christian Andersen’s fairy tale,has been described in medicine as voluntary blindness to an obvious truth,being a weak evidence-based therapeutic intervention or weak health care.A promising positive example of improving heart and kidney outcomes is the emerging treatment with sodium-glucose cotransporter 2 inhibitors.COVID-19 could boost actions for patient-centered care as a positive shift in nephrology care.展开更多
This article aims to study methodologically hospital buildings and,in particular,the strategies to design a healing garden,considered,nowadays,a key factor in the healthcare structures,based on the new frontiers of pa...This article aims to study methodologically hospital buildings and,in particular,the strategies to design a healing garden,considered,nowadays,a key factor in the healthcare structures,based on the new frontiers of patient-centeredness.Changes in medicine,culture and society have necessarily led to a new formulation of the hospital model,based on a patient-care approach,where outdoor spaces can offer both opportunities for meeting and socializing,and opportunities for distraction,not only for patients and family members,but also for caregivers and medical staff.For a patient,visitor,or member of staff,spending long hours in a hospital can be a stressful experience.Nearby access to natural landscape or a garden can enhance people’s ability to deal with stress and so improve health outcomes.The definition of design guidelines to improve and qualify the healing gardens,enhancing their performance,takes into account the fact that the established requirements of medical protocols must be accompanied by those new requirements related to the patient-centerdness.The research of this article attempts,therefore,to explore the use of technology to formulate strategies to design a healing garden,improving,in this way,the overall quality of life in the healthcare structures and promoting the users’well-being.展开更多
Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthc...Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care;resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.展开更多
Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in P...Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in Primary Health Care (PHC), and have recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with challenges in achieving the desired results in the PHC system. Thus, the study aimed to explore the factors that influence PCC utilization in the PHC facilities in Nigeria. A qualitative exploratory-descriptive design was used for this study. Data collection was conducted with the nurses from PHC facilities through individual interviews. Data saturation was achieved with 35 participants from 30 PHC facilities in Osun State, Nigeria, using a purposive sampling technique. All interviews were audio-recorded, later transcribed verbatim, and analyzed using the thematic analysis approach. NVivo 12 software was used for data management. The results from this study were categorized into two factors: Organizational factors and individual factors. Six themes that emerged from the study include inadequate management support, insufficient opportunities for further training, work overload and time constraints, health personnel readiness to use PCC, dearth enthusiasm for change, and poor nurses’ Accountability. The study shows that nurses encountered diverse challenges in providing patient-centered care. To improve the quality of healthcare delivery in the PHC facilities, there is a need to reinforce adequate management support, education, continued training, and the internal motivation of nurses to achieve transformative health outcomes in the community.展开更多
Objective: To investigate whether perceived patient-centered communication during oncology consultations relates to patient satisfaction and degree of emotional distress following the medical encounter. Methods: 226 c...Objective: To investigate whether perceived patient-centered communication during oncology consultations relates to patient satisfaction and degree of emotional distress following the medical encounter. Methods: 226 cancer patients attending an oncology outpatient clinic completed questionnaires before and after a consultation including the Physician-Patient Relationship Inventory, the brief Profile of Mood States, and the Information satisfaction questionnaire. Results: Patients who perceived the communication during the consultations to be highly patient-centered were more likely to be maximally satisfied with information provided by the oncologist. Additionally, adjusting for pre-consultation distress, as well as sociodemographic, clinical, and consultation-related variables, patients who perceived the oncologist to communicate in a highly patient-centered manner, experienced lower levels of emotional distress after the consultation. Conclusion: Patient-centered communication may be an important quality in oncology as an approach to positively influence patient outcomes, including emotional distress. However, the findings in the present study of an effect of PCC on patient satisfaction and emotional distress are modest, and no firm conclusions can thus be drawn. Practice Implications: Oncology settings may benefit from the positive effects of patient-centered care and physicians should acknowledge the potential of their own relational competence in order to facilitate patient-centered communication.展开更多
Patient-centeredness is one of the most important quality and outcome criteria in health care. Health care organizations are continually searching for approaches that will enable them to establish sustainable patient-...Patient-centeredness is one of the most important quality and outcome criteria in health care. Health care organizations are continually searching for approaches that will enable them to establish sustainable patient-centeredness in their daily practice. Existing approaches frequently focus on interaction between patient and health care professional (external participation). However, this is often not sufficient;other elements, such as good teamwork among the health care professionals (internal participation), are also essential. The model of integrated patient-centeredness differentiates between these two participations forms, both of which are explored from a patient and health care professional perspective in our study. The aim of the study was to confirm the model from the viewpoint of staff and patients. To this end we conducted a multi-center cross-sectional study consisting of a patient and staff survey to assess internal and external participation and patient-centeredness. A total of 15 rehabilitation clinics were involved, with 272 staff members and 536 patients included in the final analysis. Although evaluation was positive (mainly slightly above the middle of the scale), there was potential for improvement for both types of participation. Internal and external rating differed between patients and health care staff, with the first group assessing internal significantly better and external lower than the second group. The low to middle correlation of both types, as well as the correlation and regression with patient-centeredness, confirmed the model of integrated patient-centeredness. The model underlines the importance of both participation forms for patient-centeredness, as well as their interdependence. Further studies are needed in order to verify the impact of internal and external participation, as well as that of further possible dimensions of patient-centeredness, on clinical and functional outcome criteria.展开更多
In this article,we comment on the article by Zhang et al,which explores the familiarity,awareness,and usage of smart medical care and its correlation with mental health and personality traits.The use of intelligent he...In this article,we comment on the article by Zhang et al,which explores the familiarity,awareness,and usage of smart medical care and its correlation with mental health and personality traits.The use of intelligent healthcare technologies in treating mental disorders and substance use disorders shows significant promise,but involves certain challenges,such as limited access,low technological literacy,and privacy concerns.These barriers disproportionately affect deprived populations and individuals with severe mental health conditions.We highlight the positive impact of smart healthcare solutions,such as telemedicine and wearable technologies,on patient engagement,remote monitoring,and treatment adherence.To overcome these challenges,we propose strategies,such as improving user-friendliness,ensuring equitable access to digital interventions,enhancing cybersecurity,and integrating smart healthcare into clinical workflows.Training healthcare providers and developing policies to ensure the ethical use of patient data are essential.When implemented thoughtfully,smart healthcare technologies can revolutionize mental health and substance use disorder treatment,improve patient outcomes,and reduce healthcare inequities.展开更多
The reciprocal relationship between mental and physical health is well established.Undiagnosed,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor trea...The reciprocal relationship between mental and physical health is well established.Undiagnosed,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of life.Despite growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been criticized.The objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.展开更多
Objective:This article describes the implementation of a population-based strategy to man-age depression in a patient-centered medical home.Methods:Review of English language articles;description of specific protocols...Objective:This article describes the implementation of a population-based strategy to man-age depression in a patient-centered medical home.Methods:Review of English language articles;description of specific protocols utilized in one medical home.Results:Depression is a global concern estimated to affect 350 million people worldwide.Rates for depression vary between the United States and the Peoples’Republic of China,possibly due to significant factors in under diagnosis of this often hidden burden.Given the comorbidity of depres-sion with other health factors and the need for ongoing monitoring and care of this chronic illness,primary care has become a significant part of treatment interventions.Utilizing electronic health records(EHR),our strategy included the creation of a patient registry;selection of evidence-based treatment guidelines and protocols for point of care procedures;patient outreach and screening.Conclusion:The population-based program we outline is highly dependent on the EHR and the flexibility of roles and responsibilities of clinical staff.Further investigation is warranted into improved patient outcomes.展开更多
Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters ra...Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.展开更多
BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot program.Chron...BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot program.Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes.If proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients.AIM To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care.METHODS The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.RESULTS The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach.The coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient complexity.The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of care to be replicated.展开更多
The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a pati...The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.展开更多
BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of ...BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.展开更多
This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients f...This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients following percuta-neous coronary intervention.It further explores existing evidence and potential future research directions for MI in postoperative rehabilitation and chronic disease management.MI aims to facilitate behavioral change and promote healthier lifestyles by fostering a trusting relationship with patients and enhan-cing intrinsic motivation.Research has demonstrated its effectiveness in posto-perative recovery for oncological surgery,stroke,organ transplants,and gastroin-testinal procedures,as well as in managing chronic conditions such as diabetes,obesity,and periodontal disease.The approach is patient-centered,adaptable,cost-effective,and easily replicable,though its limitations include reliance on the therapist’s expertise,variability in individual responses,and insufficient long-term follow-up studies.Future research could focus on developing individualized and precise intervention models,exploring applications in digital health management,and confirming long-term outcomes to provide more compre-hensive support for patient rehabilitation.展开更多
The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the p...The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.展开更多
Objective:The aim of this study was to investigate the health expectations(HEs)in patients with diabetes and the factors affecting it using an integrative systematic review.Methods:A comprehensive literature search wa...Objective:The aim of this study was to investigate the health expectations(HEs)in patients with diabetes and the factors affecting it using an integrative systematic review.Methods:A comprehensive literature search was conducted in databases including PubMed,Scopus,Science Direct,Google Scholar,ProQuest,CINAHL,SID,Iran Doc,and Magiran without time limitation using related keywords.The systematic literature search was performed using a guide provided by York University.Results:From a total of 1883 articles,17 of them finally met the eligibility criteria.According to the findings of this study,HE of diabetic patients was included in four categories:“dynamism,”“consequentialism,”“comprehensive care,”and“access to facilities.”Also,these expectations can be influenced by various factors,including“developments in societies,”“changing the conditions of health care systems,”and“individual factors.”Conclusions:Health professionals should pay attention to the expectations of diabetic patients who are involved in complex disease conditions and consider meeting them as a key factor in providing patient-centered care,improving health outcomes,and patient satisfaction.展开更多
BACKGROUND Acupuncture is emerging as a promising treatment for insomnia.However,the determinants driving patients’decisions to pursue or adopt this treatment moda-lity remain underexplored.AIM To identify the key fa...BACKGROUND Acupuncture is emerging as a promising treatment for insomnia.However,the determinants driving patients’decisions to pursue or adopt this treatment moda-lity remain underexplored.AIM To identify the key factors shaping the willingness of patients with insomnia to seek and engage in acupuncture from a patient-centered perspective.METHODS A semi-structured focus group design was used,with a research framework integrating the capability,opportunity,motivation-behavior model,and theoretical domains framework.The results were mapped onto constructs of a behavioral wheel derived from the capability,opportunity,motivation-behavior/theoretical domains framework matrix.Data analyses employed abductive thematic analysis.RESULTS Data saturation was achieved after ten focus group sessions,involving a total of 45 participants.Key facilitators for patients with insomnia seeking acupuncture included:(1)Cultural beliefs in ethnic medicine;(2)Concerns about the adverse effects of,and dependence on,hypnotics;(3)Expectations of improvement in comorbid symptoms;(4)Desire for more communication with the clinician;and(5)Incentives from peers and online key opinion leaders.Barriers were:(1)Limited knowledge of acupuncture indications;(2)Accessibility burden;(3)Needle-phobia;and(4)Safety concerns.Additionally,prior acupuncture experiences,family/friend attitudes,and treatment costs(reimbursement rate in health insurance)served as both facilitators and barriers.CONCLUSION The interrelated facilitators and barriers underscore that the decision to use acupuncture for insomnia is a complex issue involving efficacy/safety,culture,economics,information dissemination,and communication factors.Expanding patient education on acupuncture,increasing media exposure,and improving governmental oversight of this process are essential.Investing in high-quality acupuncture services in public hospital nighttime clinics and community health centers is expected to address accessibility challenges.Acupuncturists need to improve doctor-patient communication,including guiding patients to set treatment expectations that are grounded in reality to enhance service quality.For patients with significant needle-phobia,cognitive manipulation or hypnosis te-chniques may be employed to improve treatment compliance.展开更多
文摘Anterior cruciate ligament(ACL)injuries are among the most frequent knee pathologies,with athletes—particularly females and those in pivot-heavy sports such as soccer,basketball,volleyball,and skiing—at increased risk.The success of ACL reconstruction is multifactorial,relying on individualized graft selection,surgical precision,patient-specific characteristics,and optimized rehabilitation.Despite the availability of various graft options—hamstring tendon,bone-patellar tendon-bone,and quadriceps tendon—no single type has demonstrated clear superiority,reinforcing the need for patient-tailored approaches based on anatomical,functional,and age-related factors.Surgical techniques continue to evolve,with adaptations such as physeal-sparing methods for skeletally immature patients and minimally invasive procedures aimed at reducing morbidity and improving recovery.Rehabilitation is a critical determinant of functional out-comes.Current evidence supports immediate mobilization,early weight-bearing,and initiation of neuromuscular and strength training,while routine use of continuous passive motion and bracing is discouraged,except in multi-ligament injuries.Prehabilitation is recommended,though accelerated rehabilitation remains controversial.Implant choice and fixation strategy are also essential to long-term success.The use of materials that reduce the risk of chronic complic-ations and support biological integration is increasingly favored.Nevertheless,rare mechanical failures emphasize the need for accurate tunnel placement,appropriate implant selection,and vigilant postoperative monitoring.Outcomes are further influenced by patient-specific variables,including bone quality,metabolic status,and physical activity levels.Optimal ACL reconstruction results from a comprehensive,patient-centered strategy that integrates surgical accuracy,individualized rehabilitation,and continuous follow-up to minimize complications and enhance recovery.
基金Supported by Ministry of Science and Technology,No.105-2410-H-030-057 and No.107-2410-H-030-072.
文摘We still do not have comprehensive knowledge of which framework of patientcentered care(PCC)is appropriate for diabetes care,which elements of PCC are evidence-based,and the mechanism by which PCC elements are associated with outcomes through mediators.In this review,we elaborate on these issues.We found that for diabetes care,PCC elements such as autonomy support(patient individuality),cooperation and collaboration(system-level approach),communication and education(behavior change techniques),emotional support(biopsychosocial approach),and family/other involvement and support are critically important.All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation.We present the practical implications of these PCC elements.
文摘This article aims to study methodologically hospital buildings and, in particular, the design of day clinics in the recovery area. The definition of design guidelines to improve and qualify the day clinic, enhancing their performance, takes into account the fact that the established requirements of medical protocols must be accompanied by those new requirements related to the massive evolution in health organizations. Changes in medicine, culture and society have necessarily led to a new formulation of the hospital model and the introduction of the theme of the humanization of the curing process has conditioned the morphological-space configuration and the presence of new relationships and spatial functions in the hospitals. The research of this article attempts, therefore, to explore the use of technology to improve the quality of day clinics’ design, formulating strategies that contribute on one side to facilitating the efficiency of service, and on the other side to making the user feel at ease in a welcoming and comfortable environment.
文摘The coronavirus disease-19(COVID-19)pandemic has been a wake-up call in which has forced us to react worldwide.Health policies and practices have attracted particular attention in terms of human and financial cost.Before COVID-19,chronic kidney disease was already considered a risk multiplier in patients with diabetes and hypertension,the two now being the major risk factors for COVID-19 infection and adverse outcome.In contrast to the urgent need for action,the nephrology field is considered to be in a state of stagnation regarding the management of chronic kidney disease patients who still experience unacceptably high morbidity and mortality.Ironically and paradoxically in a field lacking robust clinical trials,clinical practice is driven by guidelines-based medicine on weak evidence.The Emperor’s syndrome,referring to Hans Christian Andersen’s fairy tale,has been described in medicine as voluntary blindness to an obvious truth,being a weak evidence-based therapeutic intervention or weak health care.A promising positive example of improving heart and kidney outcomes is the emerging treatment with sodium-glucose cotransporter 2 inhibitors.COVID-19 could boost actions for patient-centered care as a positive shift in nephrology care.
文摘This article aims to study methodologically hospital buildings and,in particular,the strategies to design a healing garden,considered,nowadays,a key factor in the healthcare structures,based on the new frontiers of patient-centeredness.Changes in medicine,culture and society have necessarily led to a new formulation of the hospital model,based on a patient-care approach,where outdoor spaces can offer both opportunities for meeting and socializing,and opportunities for distraction,not only for patients and family members,but also for caregivers and medical staff.For a patient,visitor,or member of staff,spending long hours in a hospital can be a stressful experience.Nearby access to natural landscape or a garden can enhance people’s ability to deal with stress and so improve health outcomes.The definition of design guidelines to improve and qualify the healing gardens,enhancing their performance,takes into account the fact that the established requirements of medical protocols must be accompanied by those new requirements related to the patient-centerdness.The research of this article attempts,therefore,to explore the use of technology to formulate strategies to design a healing garden,improving,in this way,the overall quality of life in the healthcare structures and promoting the users’well-being.
文摘Patient-centered care has over the past decades, been recognized worldwide as an important component of the health system giving a wider dimension to high-quality healthcare and service delivery. The impact on healthcare and services to the patient is the nurses’ ability to create a friendly rapport with the patients. Yet, the majority in the rural Primary Health Care facilities are still facing many challenges in demonstrating patient-centeredness services to the community. Thus, the objective of this study is to explore and describe the factors influencing patient-centered care provision and nurses’ experience in Primary Health Care facilities. An exploratory qualitative approach with purposive sampling was used to gather data. Individual interviews with 35 nurses were conducted using a semi-structure interview guide question in the Primary Health Care settings in Nigeria. Each of the interviews with the nurses lasted for 25 minutes to one hour. All interviews were audio-taped, and transcribed verbatim using Microsoft Word. The transcripts were read and re-read, coded using NVivo version 12 software to organize the relevant information and categorized them into themes and sub-themes. Thematic analysis guided this study. The findings revealed three themes and sub-themes. The impact of environmental factors with two subthemes—suitable working environment and coordinated care;resources—shortage of staff and inadequate resources as sub-themes, and lastly, cultural sensitivity and religious influence—communication. Poor implementation of PCC strategies in most of the PHC facilities could lead to poor patient care and a lack of job satisfaction among nurses. This study identified that nurses have both negative and positive experience in providing patient-centered care health services. Providing patient-centered care in the Primary Health Care setting promotes the goal of achieving universal health coverage in Nigeria if the government would prioritize nurses’ pay, employ more staff, provide a conducive working environment, and opportunities for further training programs for nurses to enable and empower them with the necessary knowledge and skills. This, in turn, will translate into a range of outcomes that are socially valued, such as health responsiveness, health coverage and fairness.
文摘Globally, patient-centered care has become the focus of the healthcare system. It is imperative to note that during a global pandemic crisis, patient-centered care principles seek to empower partnering approaches in Primary Health Care (PHC), and have recently gained prominence in nursing practice and applied nursing research. However, nurses are faced with challenges in achieving the desired results in the PHC system. Thus, the study aimed to explore the factors that influence PCC utilization in the PHC facilities in Nigeria. A qualitative exploratory-descriptive design was used for this study. Data collection was conducted with the nurses from PHC facilities through individual interviews. Data saturation was achieved with 35 participants from 30 PHC facilities in Osun State, Nigeria, using a purposive sampling technique. All interviews were audio-recorded, later transcribed verbatim, and analyzed using the thematic analysis approach. NVivo 12 software was used for data management. The results from this study were categorized into two factors: Organizational factors and individual factors. Six themes that emerged from the study include inadequate management support, insufficient opportunities for further training, work overload and time constraints, health personnel readiness to use PCC, dearth enthusiasm for change, and poor nurses’ Accountability. The study shows that nurses encountered diverse challenges in providing patient-centered care. To improve the quality of healthcare delivery in the PHC facilities, there is a need to reinforce adequate management support, education, continued training, and the internal motivation of nurses to achieve transformative health outcomes in the community.
基金supported by The Health Research Fund of central Region DenmarkThe Danish Cancer Society,grant no.OKV 08020.
文摘Objective: To investigate whether perceived patient-centered communication during oncology consultations relates to patient satisfaction and degree of emotional distress following the medical encounter. Methods: 226 cancer patients attending an oncology outpatient clinic completed questionnaires before and after a consultation including the Physician-Patient Relationship Inventory, the brief Profile of Mood States, and the Information satisfaction questionnaire. Results: Patients who perceived the communication during the consultations to be highly patient-centered were more likely to be maximally satisfied with information provided by the oncologist. Additionally, adjusting for pre-consultation distress, as well as sociodemographic, clinical, and consultation-related variables, patients who perceived the oncologist to communicate in a highly patient-centered manner, experienced lower levels of emotional distress after the consultation. Conclusion: Patient-centered communication may be an important quality in oncology as an approach to positively influence patient outcomes, including emotional distress. However, the findings in the present study of an effect of PCC on patient satisfaction and emotional distress are modest, and no firm conclusions can thus be drawn. Practice Implications: Oncology settings may benefit from the positive effects of patient-centered care and physicians should acknowledge the potential of their own relational competence in order to facilitate patient-centered communication.
基金German Ministry of Education and Research The German statutory pension insurance scheme (project number: 01GX720)
文摘Patient-centeredness is one of the most important quality and outcome criteria in health care. Health care organizations are continually searching for approaches that will enable them to establish sustainable patient-centeredness in their daily practice. Existing approaches frequently focus on interaction between patient and health care professional (external participation). However, this is often not sufficient;other elements, such as good teamwork among the health care professionals (internal participation), are also essential. The model of integrated patient-centeredness differentiates between these two participations forms, both of which are explored from a patient and health care professional perspective in our study. The aim of the study was to confirm the model from the viewpoint of staff and patients. To this end we conducted a multi-center cross-sectional study consisting of a patient and staff survey to assess internal and external participation and patient-centeredness. A total of 15 rehabilitation clinics were involved, with 272 staff members and 536 patients included in the final analysis. Although evaluation was positive (mainly slightly above the middle of the scale), there was potential for improvement for both types of participation. Internal and external rating differed between patients and health care staff, with the first group assessing internal significantly better and external lower than the second group. The low to middle correlation of both types, as well as the correlation and regression with patient-centeredness, confirmed the model of integrated patient-centeredness. The model underlines the importance of both participation forms for patient-centeredness, as well as their interdependence. Further studies are needed in order to verify the impact of internal and external participation, as well as that of further possible dimensions of patient-centeredness, on clinical and functional outcome criteria.
文摘In this article,we comment on the article by Zhang et al,which explores the familiarity,awareness,and usage of smart medical care and its correlation with mental health and personality traits.The use of intelligent healthcare technologies in treating mental disorders and substance use disorders shows significant promise,but involves certain challenges,such as limited access,low technological literacy,and privacy concerns.These barriers disproportionately affect deprived populations and individuals with severe mental health conditions.We highlight the positive impact of smart healthcare solutions,such as telemedicine and wearable technologies,on patient engagement,remote monitoring,and treatment adherence.To overcome these challenges,we propose strategies,such as improving user-friendliness,ensuring equitable access to digital interventions,enhancing cybersecurity,and integrating smart healthcare into clinical workflows.Training healthcare providers and developing policies to ensure the ethical use of patient data are essential.When implemented thoughtfully,smart healthcare technologies can revolutionize mental health and substance use disorder treatment,improve patient outcomes,and reduce healthcare inequities.
文摘The reciprocal relationship between mental and physical health is well established.Undiagnosed,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of life.Despite growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been criticized.The objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.
文摘Objective:This article describes the implementation of a population-based strategy to man-age depression in a patient-centered medical home.Methods:Review of English language articles;description of specific protocols utilized in one medical home.Results:Depression is a global concern estimated to affect 350 million people worldwide.Rates for depression vary between the United States and the Peoples’Republic of China,possibly due to significant factors in under diagnosis of this often hidden burden.Given the comorbidity of depres-sion with other health factors and the need for ongoing monitoring and care of this chronic illness,primary care has become a significant part of treatment interventions.Utilizing electronic health records(EHR),our strategy included the creation of a patient registry;selection of evidence-based treatment guidelines and protocols for point of care procedures;patient outreach and screening.Conclusion:The population-based program we outline is highly dependent on the EHR and the flexibility of roles and responsibilities of clinical staff.Further investigation is warranted into improved patient outcomes.
文摘Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.
基金Supported by Fundación Progreso y Salud,No.AP-0306-2022-C3-F2.
文摘BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot program.Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes.If proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients.AIM To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care.METHODS The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.RESULTS The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach.The coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient complexity.The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of care to be replicated.
文摘The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.
文摘BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.
文摘This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients following percuta-neous coronary intervention.It further explores existing evidence and potential future research directions for MI in postoperative rehabilitation and chronic disease management.MI aims to facilitate behavioral change and promote healthier lifestyles by fostering a trusting relationship with patients and enhan-cing intrinsic motivation.Research has demonstrated its effectiveness in posto-perative recovery for oncological surgery,stroke,organ transplants,and gastroin-testinal procedures,as well as in managing chronic conditions such as diabetes,obesity,and periodontal disease.The approach is patient-centered,adaptable,cost-effective,and easily replicable,though its limitations include reliance on the therapist’s expertise,variability in individual responses,and insufficient long-term follow-up studies.Future research could focus on developing individualized and precise intervention models,exploring applications in digital health management,and confirming long-term outcomes to provide more compre-hensive support for patient rehabilitation.
文摘The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.
基金supported by Tehran University of Medical Sciences,Tehran,Iran(no.9711199007).
文摘Objective:The aim of this study was to investigate the health expectations(HEs)in patients with diabetes and the factors affecting it using an integrative systematic review.Methods:A comprehensive literature search was conducted in databases including PubMed,Scopus,Science Direct,Google Scholar,ProQuest,CINAHL,SID,Iran Doc,and Magiran without time limitation using related keywords.The systematic literature search was performed using a guide provided by York University.Results:From a total of 1883 articles,17 of them finally met the eligibility criteria.According to the findings of this study,HE of diabetic patients was included in four categories:“dynamism,”“consequentialism,”“comprehensive care,”and“access to facilities.”Also,these expectations can be influenced by various factors,including“developments in societies,”“changing the conditions of health care systems,”and“individual factors.”Conclusions:Health professionals should pay attention to the expectations of diabetic patients who are involved in complex disease conditions and consider meeting them as a key factor in providing patient-centered care,improving health outcomes,and patient satisfaction.
基金Supported by Scientific Research Fund Project of Shanghai Sanda University,No.2024BSZX03.
文摘BACKGROUND Acupuncture is emerging as a promising treatment for insomnia.However,the determinants driving patients’decisions to pursue or adopt this treatment moda-lity remain underexplored.AIM To identify the key factors shaping the willingness of patients with insomnia to seek and engage in acupuncture from a patient-centered perspective.METHODS A semi-structured focus group design was used,with a research framework integrating the capability,opportunity,motivation-behavior model,and theoretical domains framework.The results were mapped onto constructs of a behavioral wheel derived from the capability,opportunity,motivation-behavior/theoretical domains framework matrix.Data analyses employed abductive thematic analysis.RESULTS Data saturation was achieved after ten focus group sessions,involving a total of 45 participants.Key facilitators for patients with insomnia seeking acupuncture included:(1)Cultural beliefs in ethnic medicine;(2)Concerns about the adverse effects of,and dependence on,hypnotics;(3)Expectations of improvement in comorbid symptoms;(4)Desire for more communication with the clinician;and(5)Incentives from peers and online key opinion leaders.Barriers were:(1)Limited knowledge of acupuncture indications;(2)Accessibility burden;(3)Needle-phobia;and(4)Safety concerns.Additionally,prior acupuncture experiences,family/friend attitudes,and treatment costs(reimbursement rate in health insurance)served as both facilitators and barriers.CONCLUSION The interrelated facilitators and barriers underscore that the decision to use acupuncture for insomnia is a complex issue involving efficacy/safety,culture,economics,information dissemination,and communication factors.Expanding patient education on acupuncture,increasing media exposure,and improving governmental oversight of this process are essential.Investing in high-quality acupuncture services in public hospital nighttime clinics and community health centers is expected to address accessibility challenges.Acupuncturists need to improve doctor-patient communication,including guiding patients to set treatment expectations that are grounded in reality to enhance service quality.For patients with significant needle-phobia,cognitive manipulation or hypnosis te-chniques may be employed to improve treatment compliance.
